Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston, IL.
Surgery. 2013 Oct;154(4):893-7; discussion 897-900. doi: 10.1016/j.surg.2013.04.042.
We report our short-term experience with peroral endoscopic myotomy (POEM) and compare perioperative outcomes with laparoscopic Heller myotomy (LHM) for achalasia.
Patients from an institutional review board-approved protocol underwent POEM and were followed prospectively. Comparisons were made, in a prospective esophageal database, with patients who underwent LHM over the same period.
We studied 18 patients who underwent POEM and compared them to 21 who underwent LHM. Demographics, preoperative Eckardt scores, motility data, and prior intervention history were comparable. Operative time, myotomy length, and complication rates (1 perforation in each group) were equal. Postoperative pain was significantly different by visual analogue score (POEM 3.9 ± 0.6 versus LHM 5.7 ± 0.4, P = .02) and analgesic use (POEM 26.0 ± 13.7 versus LHM 90.0 ± 48.5 mg morphine, P = .02). Return to activities of daily living was significantly faster in the POEM group (2.2 ± 0.6 vs 6.4 ± 1.0 days, P = .03). Postoperative dysphagia and Eckardt scores were equally successful in both groups.
POEM results in similar relief of dysphagia with less postoperative pain and quicker return to normal activities.
我们报告了经口内镜肌切开术（POEM）的短期经验，并将其与腹腔镜 Heller 肌切开术（LHM）治疗贲门失弛缓症的围手术期结果进行了比较。
根据机构审查委员会批准的方案，患者接受 POEM 治疗，并进行前瞻性随访。同时，在同一时期，我们将前瞻性食管数据库中接受 LHM 的患者进行了比较。
我们研究了 18 例接受 POEM 的患者，并将其与 21 例接受 LHM 的患者进行了比较。人口统计学、术前 Eckardt 评分、动力数据和既往干预史均相似。手术时间、肌切开长度和并发症发生率（每组各有 1 例穿孔）相等。术后疼痛通过视觉模拟评分（POEM 为 3.9 ± 0.6，LHM 为 5.7 ± 0.4，P =.02）和镇痛药使用（POEM 为 26.0 ± 13.7，LHM 为 90.0 ± 48.5 mg 吗啡，P =.02）差异有统计学意义。POEM 组恢复日常生活活动的速度明显更快（2.2 ± 0.6 天 vs 6.4 ± 1.0 天，P =.03）。两组术后吞咽困难和 Eckardt 评分均取得同等效果。
POEM 治疗贲门失弛缓症同样能缓解吞咽困难，术后疼痛较轻，恢复正常活动更快。
